Category: Statistics

Ann Vasc Surg. 2022 Nov 26:S0890-5096(22)00729-4. doi: 10.1016/j.avsg.2022.10.008. Online ahead of print.

ABSTRACT

OBJECTIVES: Thoracic Endovascular Aortic Repair (TEVAR) is a minimally invasive surgery for repairing thoracic aneurysms and dissections. This study aims to compare postoperative outcomes of TEVAR performed under general versus locoregional anesthesia.

MATERIAL AND METHODS: Utilizing the 2008-2019 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, patients older than the age of 18 years who received TEVAR, were identified using the following current procedural terminology codes: 33880, 33881, 33883, 33884, or 33886. Patients who underwent concomitant procedures, those with both thoraco-abdominal and abdominal aortic pathologies, and trauma cases were excluded. Standard descriptive statistics, in addition to χ², Fisher’s exact, and Mann-Whitney U tests were used to compare patient baseline characteristics and postoperative outcomes between general and locoregional anesthesia groups, as appropriate. Univariable and multivariable logistic regression analyses were performed to assess independent predictors of hospital length of stay (LOS) greater than 7 days.

RESULTS: Of the 1,028 patients included in the study, 86.5% received general anesthesia, and 13.5% received locoregional anesthesia, such as local anesthesia with monitored anesthesia care or regional anesthesia. No significant differences were found between patients receiving locoregional vs general anesthesia in mortality (3.6% vs 7.9%, respectively, p=0.071) and morbidity (18.7% and 24.8%, respectively, p=0.121) within 30 days post-TEVAR, including any wound, pulmonary, thromboembolic, renal, septic, and cardiac arrest complications. Patients who received general anesthesia had significantly higher median LOS compared to those who received locoregional anesthesia [5 days (IQR: 3-10) vs 4 days (IQR: 2-7), p=0.002], with 34.3% of the general anesthesia group having a LOS greater than 7 days compared to 21.6% of locoregional anesthesia group, p=0.003. On multivariable logistic regression analysis, general anesthesia was found to be an independent predictor of prolonged LOS greater than 7 days (OR: 1.72, 95% CI: 1.05-2.81, p=0.031).

CONCLUSION: Locoregional anesthesia results in significantly lower postoperative hospital LOS with similar postoperative mortality and morbidity compared to general anesthesia in patients undergoing TEVAR.

PMID:36574571 | DOI:10.1016/j.avsg.2022.10.008

J Gerontol A Biol Sci Med Sci. 2022 Dec 27:glac256. doi: 10.1093/gerona/glac256. Online ahead of print.

ABSTRACT

BACKGROUND: This study was performed to derive and validate a prognostic prediction model for individualized estimation of mortality risk among the frail oldest old (aged 80 years or older).

METHODS: This analysis was based on the prospective open cohort study from the Chinese Longevity and Health Longitudinal Survey. A total of 14118 frail oldest old were included from the 2002 wave to 2014 waves; the study outcome was all-cause mortality. Available predictors included frailty, demographics, and social factors. Cox models were used to estimate the coefficients of the predictors and least absolute shrinkage and selection operator (LASSO) was used for selecting predictors. Model performance was measured by discrimination and calibration with internal validation by bootstrapping. We also developed a nomogram to visualize and predict the three-year mortality risk based on the obtained prognostic prediction model.

RESULTS: During the 16-years follow-up, 10410 (76.42%) deaths were identified. The final model comprises the following factors: frailty, age, sex, race, birthplace, education, occupation, marital status, residence, economic condition, number of children, and the question “who do you ask for help first when in trouble”. The model has valid predictive ability as measured and validated by Harrell’s C statistic (0.602) and calibration plots.

CONCLUSIONS: This study provides a basic prognostic prediction model to quantify absolute mortality risk for the frail oldest old. Future studies are needed, firstly, to update, adjust, and perform external validation of the present model by using phenotypic frailty, and secondly, to add biomarkers, environmental, and psychological factors to the prediction model.

PMID:36574506 | DOI:10.1093/gerona/glac256

Hum Factors. 2022 Dec 27:187208221145264. doi: 10.1177/00187208221145264. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the effect of gender transfer in virtual reality on implicit gender bias.

BACKGROUND: Gender bias is a type of discrimination based on gender, which can lead to increased self-doubt and decreased self-esteem. Sexual harassment is a hostile form of gender bias that can cause anxiety, depression, and significant mental health issues. Virtual reality (VR) has been employed to help make people become aware of their biases and change their attitudes regarding gender, race, and age.

METHODS: Forty participants were embodied in avatars of different genders and experienced sexual harassment scenarios in VR. A gender Implicit Association Test (IAT) was administered before and after the experience.

RESULTS: There was a statistically significant main effect of participant gender (F (1,36) = 10.67, p = .002, partial η² = .23) on ΔIAT, where males and females reported a decrease (M = -.12, SD = .24) and an increase (M = .10, SD = .25) in IAT scores, respectively. A statistically significant two-way interaction between gender transfer and participant gender was revealed (F (1,36) = 6.32, p = .02, partial η² = .15). There was a significant simple effect of gender transfer for male participants (F (1,36) = 8.70, p = .006, partial η² = .19).

CONCLUSIONS: Implicit gender bias can be modified, at least temporarily, through embodiment in VR. Gender transfer through embodiment while encountering different sexual harassment scenarios helped reduce implicit gender bias. There was a tendency for individuals to increase bias for the gender of the avatar in which they embodied.

APPLICATIONS: The current research provided promising evidence that a virtual environment system may be used as a potential training tool to improve implicit gender bias.

PMID:36574504 | DOI:10.1177/00187208221145264

Nicotine Tob Res. 2022 Dec 27:ntac294. doi: 10.1093/ntr/ntac294. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the percentage and correlates of giving and receiving cigarettes as gifts among adult non-smokers in China.

METHODS: We analyzed non-smokers (N=1,813) aged ≥18 years using data from the International Tobacco Control China Wave 5 Survey. Descriptive statistics summarized the characteristics of those who gave and received cigarettes as gifts. Multivariable logistic regression models were used to identify factors associated with the two behaviors.

RESULTS: Among non-smokers, 9.9% reported giving cigarettes as gifts to family or friends in the last 6 months. Higher level of knowledge about smoking harms was associated with lower adjusted odds of gifting cigarettes. Non-smokers aged 25-39, with middle income, positive attitude toward cigarette gifts, exposure to anti-smoking information and smoking promotion, and those who reported receiving cigarettes as gifts from family or friends were more likely to give cigarettes as gifts. 6.6% of non-smokers reported receiving cigarettes as gifts in the last 6 months. High education, neutral or positive attitude toward cigarette gifts, exposure to anti-smoking information, exposure to smoking promotion, and having smoking friends were associated with receiving cigarettes as gifts.

CONCLUSIONS: It is concerning that Chinese cultural norms that support cigarette gifting have extended to giving non-smokers cigarettes as gifts. Effective anti-smoking messages are needed. Changing the norms around cigarette gifting and increasing knowledge about smoking harms should help reduce cigarette gifting among non-smokers.

IMPLICATIONS: Easy access to cigarettes received as gifts, along with the wide acceptance of smoking in China, places Chinese non-smokers in a risky position. More educational campaigns targeting non-smokers to proactively prevent them from smoking are called for.The ineffectiveness of existing anti-smoking information highlights the need for more effective anti-smoking messages.That attitude toward cigarette gifts is the strongest predictor of giving cigarettes as gifts suggests a need for interventions to reverse the positive attitude about cigarette gifting in order to decrease the popularity of this activity.

PMID:36574502 | DOI:10.1093/ntr/ntac294

PLoS Genet. 2022 Dec 27;18(12):e1010557. doi: 10.1371/journal.pgen.1010557. Online ahead of print.

ABSTRACT

Genetic association studies of many heritable traits resulting from physiological testing often have modest sample sizes due to the cost and burden of the required phenotyping. This reduces statistical power and limits discovery of multiple genetic associations. We present a strategy to leverage pleiotropy between traits to both discover new loci and to provide mechanistic hypotheses of the underlying pathophysiology. Specifically, we combine a colocalization test with a locus-level test of pleiotropy. In simulations, we show that this approach is highly selective for identifying true pleiotropy driven by the same causative variant, thereby improves the chance to replicate the associations in underpowered validation cohorts and leads to higher interpretability. Here, as an exemplar, we use Obstructive Sleep Apnea (OSA), a common disorder diagnosed using overnight multi-channel physiological testing. We leverage pleiotropy with relevant cellular and cardio-metabolic phenotypes and gene expression traits to map new risk loci in an underpowered OSA GWAS. We identify several pleiotropic loci harboring suggestive associations to OSA and genome-wide significant associations to other traits, and show that their OSA association replicates in independent cohorts of diverse ancestries. By investigating pleiotropic loci, our strategy allows proposing new hypotheses about OSA pathobiology across many physiological layers. For example, we identify and replicate the pleiotropy across the plateletcrit, OSA and an eQTL of DNA primase subunit 1 (PRIM1) in immune cells. We find suggestive links between OSA, a measure of lung function (FEV1/FVC), and an eQTL of matrix metallopeptidase 15 (MMP15) in lung tissue. We also link a previously known genome-wide significant peak for OSA in the hexokinase 1 (HK1) locus to hematocrit and other red blood cell related traits. Thus, the analysis of pleiotropic associations has the potential to assemble diverse phenotypes into a chain of mechanistic hypotheses that provide insight into the pathogenesis of complex human diseases.

PMID:36574455 | DOI:10.1371/journal.pgen.1010557

PLoS Negl Trop Dis. 2022 Dec 27;16(12):e0010985. doi: 10.1371/journal.pntd.0010985. Online ahead of print.

ABSTRACT

BACKGROUND: Improved education on water-related diseases in schools could help to reduce disease burden. This paper presents specific results on knowledge, attitudes and practices (KAP) of a cluster-randomized controlled trial to reduce diarrheal disease and dengue entomological risk factors in rural primary schools in Colombia. The aim was to investigate whether enhanced educational interventions on dengue and diarrheal disease in schools could improve KAP scores related to these diseases in students and teachers in rural primary schools, as well as the students’ parents.

METHODOLOGY/PRINCIPAL FINDINGS: A factorial cluster-randomized controlled trial was carried out in 35 rural primary schools in two municipalities in Cundinamarca, central Colombia. Schools were randomized into four arms: interventions related to diarrheal disease (DIA), dengue (DEN), both (DIADEN), or no interventions (control, CON). Both educational and physical interventions to reduce risk factors of dengue and diarrhea were implemented. Comprehensive teachers’ manuals were developed and deployed to guide the learning activities. The intervention was carried out over two school years. The knowledge scores of students receiving dengue interventions (DEN, DIADEN) increased by 1.16 point score (0.75-1.56, p<0.001) and those receiving diarrhea interventions (DIA, DIADEN) increased by 1.15 point score (0.67-1.63, p<0.001). The attitude and practice scores of students receiving the diarrhea interventions increased (Attitudes: 0.41 [0.11-0.71, p = 0.01]; Practices: 0.33 [0.01-0.65, p = 0.042]), but not for those receiving the dengue interventions (p = 0.31 and p = 0.08, respectively).

CONCLUSIONS/SIGNIFICANCE: There were increases in knowledge scores among students, their teachers and their parents for both diseases. However, the attitudes and practices components were not affected to the same extent. The hypothesis that the students would disseminate knowledge acquired from the educational interventions to their parents was confirmed for dengue, but not for diarrhea.

TRIAL REGISTRATION: ISRCTN40195031 The trial is registered in the Current Controlled Trials under Infections and Infestations category.

PMID:36574453 | DOI:10.1371/journal.pntd.0010985

PLoS One. 2022 Dec 27;17(12):e0279714. doi: 10.1371/journal.pone.0279714. eCollection 2022.

ABSTRACT

INTRODUCTION: The prevalence of Mycobacterium avium complex (MAC) is increasing globally. Macrolide-based multidrug regimens have been recommended as the first-line treatment for patients with MAC pulmonary disease. However, developing macrolide resistance was associated with poor treatment outcomes and increased mortality. In 2018, the U.S. Food and Drug Administration approved liposomal amikacin for inhalation (LAI) to treat refractory MAC pulmonary disease. The current systematic review aimed to evaluate LAI’s outcomes and adverse events in MAC pulmonary disease.

METHODS: The systematic search was performed in PubMed/Medline, EMBASE, and the Cochrane Controlled Register of Trials (CENTRAL) up to March 8, 2022. The search terms included Mycobacterium avium complex, MAC, amikacin, and liposomal amikacin.

RESULTS: After reviewing 1284 records, four papers met the inclusion criteria, including three clinical trials and one prospective cohort study. These studies showed that adding LAI to guideline-based therapies can increase sputum culture conversion rate and achieve early sustained (negative sputum culture results for 12 months with treatment) and durable (negative sputum culture results for three months after treatment) negative sputum culture. In addition, extended LAI use was a potential benefit in patients considered refractory to initial treatment. The most prevalent treatment-emergent adverse events (TEAE) reported in the LAI group were the respiratory TEAE.

CONCLUSIONS: LAI could increase the sputum culture conversion rate and achieve early sustainable, durable negative sputum culture. However, additional large-scale research is required to confirm the results.

PMID:36574432 | DOI:10.1371/journal.pone.0279714

PLoS One. 2022 Dec 27;17(12):e0279706. doi: 10.1371/journal.pone.0279706. eCollection 2022.

ABSTRACT

OBJECTIVE: Ischemic stroke (IS) with subsequent cerebrocardiac syndrome (CCS) has a poor prognosis. We aimed to investigate electrocardiogram (ECG) changes after IS with artificial intelligence (AI).

METHODS: We collected ECGs from a healthy population and patients with IS, and then analyzed participant demographics and ECG parameters to identify abnormal features in post-IS ECGs. Next, we trained the convolutional neural network (CNN), random forest (RF) and support vector machine (SVM) models to automatically detect the changes in the ECGs; Additionally, We compared the CNN scores of good prognosis (mRS ≤ 2) and poor prognosis (mRS > 2) to assess the prognostic value of CNN model. Finally, we used gradient class activation map (Grad-CAM) to localize the key abnormalities.

RESULTS: Among the 3506 ECGs of the IS patients, 2764 ECGs (78.84%) led to an abnormal diagnosis. Then we divided ECGs in the primary cohort into three groups, normal ECGs (N-Ns), abnormal ECGs after the first ischemic stroke (A-ISs), and normal ECGs after the first ischemic stroke (N-ISs). Basic demographic and ECG parameter analyses showed that heart rate, QT interval, and P-R interval were significantly different between 673 N-ISs and 3546 N-Ns (p < 0.05). The CNN has the best performance among the three models in distinguishing A-ISs and N-Ns (AUC: 0.88, 95%CI = 0.86-0.90). The prediction scores of the A-ISs and N-ISs obtained from the all three models are statistically different from the N-Ns (p < 0.001). Futhermore, the CNN scores of the two groups (mRS > 2 and mRS ≤ 2) were significantly different (p < 0.05). Finally, Grad-CAM revealed that the V4 lead may harbor the highest probability of abnormality.

CONCLUSION: Our study showed that a high proportion of post-IS ECGs harbored abnormal changes. Our CNN model can systematically assess anomalies in and prognosticate post-IS ECGs.

PMID:36574427 | DOI:10.1371/journal.pone.0279706

PLoS One. 2022 Dec 27;17(12):e0279472. doi: 10.1371/journal.pone.0279472. eCollection 2022.

ABSTRACT

The automatic sorting of construction waste (CW) is an essential procedure in the field of CW recycling due to its remarkable efficiency and safety. The classification of CW is the primary task that guides automatic and precise sorting. In our work, a new method of CW classification based on two-level fusion is proposed to promote classification performance. First, statistical histograms are used to obtain global hue information and local oriented gradients, which are called the hue histogram (HH) and histogram of oriented gradients (HOG), respectively. To fuse these visual features, a bag-of-visual-words (BoVW) method is applied to code HOG descriptors in a CW image as a vector, and this process is named B-HOG. Then, based on feature-level fusion, we define a new feature to combine HH and B-HOG, which represent the global and local visual characteristics of an object in a CW image. Furthermore, two base classifiers are used to learn the information from the color feature space and the new feature space. Based on decision-level fusion, we propose a joint decision-making model to combine the decisions from the two base classifiers for the final classification result. Finally, to verify the performance of the proposed method, we collect five types of CW images as the experimental data set and use these images to conduct experiments on three different base classifiers. Moreover, we compare this method with other extant methods. The results demonstrate that our method is effective and feasible.

PMID:36574416 | DOI:10.1371/journal.pone.0279472

PLoS One. 2022 Dec 27;17(12):e0279518. doi: 10.1371/journal.pone.0279518. eCollection 2022.

ABSTRACT

PURPOSE: To assess the rate of pseudophakic cystoid macular edema (pCME) in uneventful cataract surgery in surgeons in training vs experienced surgeons and to analyze the rate of pCME according to surgeon’s sex.

METHODS: Medical reports post phacoemulsification between 2010 and 2018 at the Department of Ophthalmology, Medical University of Graz, Austria, were reviewed for pCME. A running lifetime number of preceding cataract surgeries was used to express hands-on experience. A cut-off number of 300 surgeries was defined to distinguish between surgeons in training and experienced surgeons. Outcome parameters were incidence of pCME, patient’s sex and age, laterality of eye, coexistence of pseudoexfoliation syndrome (PEX), duration of surgery and surgeon’s sex.

RESULTS: 25.422 surgeries on 18.266 patients were included. The majority was performed by experienced surgeons (23.139, 91.0%) vs 2.283 (9.0%) by surgeons in training (25 surgeons, 9 (36%) female and 16 (64%) male). pCME occurred in 32 eyes (1.4%) following surgery by surgeons in training and in 152 eyes (0.7%) following surgery by experienced surgeons. Chance for pCME was 1.57 higher in training surgeries (95% CI 1.03-2.41, p = 0.034) and longer duration (OR = 1.04; 95% CI 1.02-1.07, p = 0.001). After excluding the first 100 surgeries for every surgeon in training similar results were observed. No difference in risk for pCME was found between female and male surgeons in both groups (training and experienced surgeons).

CONCLUSION: In conclusion, the rate for pCME after uneventful cataract surgery is significantly higher for surgeons in training but steadily decreasing and associated to surgical time. No difference in the risk for pCME was found between female and male surgeons.

PMID:36574394 | DOI:10.1371/journal.pone.0279518